DIET & NUTRITION 
PATIENT EDUCATION 
OBESITY/WEIGHT MANAGEMENT 
EXERCISE/TRAINING 
LEGAL MATTERS 
GUIDELINES/RECOMMENDATIONS A PRISMA-registered systematic review of 12 studies and 242 adolescent patients finds that informal coercion, including silencing, exclusion, threats, and treatment pressure, is common in mental health settings and causes emotional distress, treatment disengagement, and damaged therapeutic trust. Findings are strongest for inpatient psychiatric settings with predominantly female participants; nurses in outpatient or community settings should apply them with that context in mind.
Clinical Considerations
- Adolescents excluded from care decisions respond with concealment and feigned wellness, actively hiding their true condition from providers.
- Rigid rules, collective punishment, and threats of more restrictive treatment were the most common coercive practices reported across settings.
- Coercion damaged the therapeutic relationship in most cases; only a small subset of adolescents perceived structured pressure as supportive or protective.
- Existing frameworks for identifying informal coercion are based on adults and miss the relational, subtle forms adolescents actually experience.
Practice Applications
- Involve adolescent patients directly in care planning and treatment decisions, even when time is limited.
- Examine routine ward practices, such as rules and restrictions, for whether they serve therapeutic goals or function as control.
- Recognize concealment and feigned improvement as potential signs of a coercive care dynamic, not successful treatment.
- Explain the rationale behind rules, restrictions, and treatment expectations rather than citing policy alone.
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